Development of anti-Jk3 associated with silenced Kidd antigen expression and a novel single nucleotide variant of the JK gene.

Anti-Jk3 is a rare alloantibody to a high-prevalence antigen primarily seen in individuals of Polynesian descent and is associated with a handful of well-established variants of the SLC14A1 gene. We report a case of the Jknull phenotype, associated with formation of anti-Jk3, in a patient of non-Polynesian descent. This patient, a 51-year-old woman self-described as of Jamaican and Scottish ancestry, presented to our hospital for oncologic care. The patient's blood sample typed as blood group A, D+. All screening and panel reagent red blood cells showed reactivity, ranging from 2 to 4+; autocontrol and direct antiglobulin test were both negative. Antigen phenotyping revealed Jk(a-b-), leading to suspicion for anti-Jk3, which was subsequently confirmed by our immunohematology reference laboratory. Given her reported familial background, testing of the SLC14A1 gene was performed, revealing that the patient was heterozygous for the single nucleotide variant (SNV) at c.838G>A in exon 8 and therefore carries both JK*01 and JK*02 alleles that encode Jka and Jkb, respectively. However, the patient was found to be heterozygous for several additional SNVs: c.28G>A in exon 3; c.191G>A, c.226G>A, and c.303G>A in exon 4; and c.757T>C in exon 7. The patient's Jk(b-) phenotype can be explained by coinheritance of c.838A with c.191G>A, which defines null allele JK*02N.09. Coinheritance of SNVs c.28G>A and c.838G with rare SNV c.757C that is predicted to cause a non-conservative amino acid change (p.S253P) likely accounts for the complete serologic absence of Jka and the ability to form anti-Jk3 in this case. This finding would represent a new JK*01 null allele. This evaluation illustrates the importance of genetic analysis in identifying the factors preventing a high-prevalence antigen from being expressed, particularly when discovered outside of an expected racial or ethnic group.Anti-Jk3 is a rare alloantibody to a high-prevalence antigen primarily seen in individuals of Polynesian descent and is associated with a handful of well-established variants of the SLC14A1 gene. We report a case of the Jknull phenotype, associated with formation of anti-Jk3, in a patient of non-Polynesian descent. This patient, a 51-year-old woman self-described as of Jamaican and Scottish ancestry, presented to our hospital for oncologic care. The patient's blood sample typed as blood group A, D+. All screening and panel reagent red blood cells showed reactivity, ranging from 2 to 4+; autocontrol and direct antiglobulin test were both negative. Antigen phenotyping revealed Jk(a­b­), leading to suspicion for anti-Jk3, which was subsequently confirmed by our immunohematology reference laboratory. Given her reported familial background, testing of the SLC14A1 gene was performed, revealing that the patient was heterozygous for the single nucleotide variant (SNV) at c.838G>A in exon 8 and therefore carries both JK*01 and JK*02 alleles that encode Jka and Jkb, respectively. However, the patient was found to be heterozygous for several additional SNVs: c.28G>A in exon 3; c.191G>A, c.226G>A, and c.303G>A in exon 4; and c.757T>C in exon 7. The patient's Jk(b­) phenotype can be explained by coinheritance of c.838A with c.191G>A, which defines null allele JK*02N.09. Coinheritance of SNVs c.28G>A and c.838G with rare SNV c.757C that is predicted to cause a non-conservative amino acid change (p.S253P) likely accounts for the complete serologic absence of Jka and the ability to form anti-Jk3 in this case. This finding would represent a new JK*01 null allele. This evaluation illustrates the importance of genetic analysis in identifying the factors preventing a high-prevalence antigen from being expressed, particularly when discovered outside of an expected racial or ethnic group.

[Alzheimer dementia: course and burden on caregivers : Data over 18 months from German participants of the GERAS study]. / Alzheimer-Demenz: Verlauf und Belastung der Pflegepersonen : 18-Monats-Daten der deutschen Teilnehmer der GERAS-Studie.

The GERAS study is an international observational study with dementia patients of the Alzheimer type (AD) and their caregivers in everyday care. The 18-month data recorded in Germany are presented. Disease progression, medical and psychosocial consequences for both patients and caregivers were recorded using commonly used tests in clinical care: the mini mental status examination (MMSE), Alzheimer's disease assessment scale (ADAS-Cog14), Alzheimer's disease cooperative study activities of daily living inventory (ADCS-ADL), neuropsychiatric inventory (NPI-12), resource utilization in dementia (RUD) and the Zarit burden interview (ZBI). Definition of AD severity level (MMSE): 21-26 mild (miAD), 15-20 moderate (moAD), <15 moderately severe to severe (m/sAD). For the 550 participants (mean age: 75.2 years, SD 7.6 years), miAD (41.5%), moAD (28.4%) and m/sAD (30.2%), the MMSE worsened: in miAD by -2.4 (CI -3.1/-1.7), in moAD by -3.9 (CI -5.0/-2.8) and in m/sAD by -2.5 (CI -3.5/-1.5) at 18 months and the ADAS-Cog14 by 6.2 (miAD-CI 4.6/7.8) and 7.1 points (moAD CI 3.9/10.3). Changes in overall ADCS-ADL amounted to -8.4 (CI -10.1/-6.2) for miAD, -12.9 (CI -15.3/-10.4) for moAD and -10.2 points (CI-12.8/-7.7) for m/sAD. Caregiver burden (NPI-12) rose in miAD by 1.2 points (CI -0.2/2.2), in moAD by 3.4 (CI 1.8/5.1) and in m/sAD by 1.5 points (CI 0.2/3.3). At study start, the total time required by caregivers (RUD) was 3.1 h/day (SD 5.4 h/day) for miAD, 6.6 (SD 7.5) for moAD and 12.7 (SD 9.3) for m/sAD. With 4.4 (SD 9.4) h/day, the increase after 18 months was highest in moAD. Caregiver burden (ZBI) increased most markedly in moAD with 7.2 (CI 4.2/9.7), 90.7% of the patients received antidementia drugs, while 26.6% received psychotropic medication.

Are even geriatric patients becoming older and older? : Changes in the age structure of geriatric inpatients in the course of two decades.

BACKGROUND: The life expectancy of the German population has steadily risen in the course of the past decades. As especially the oldest members of the population are treated in geriatric clinics, it would be of interest to investigate whether the increase in population age can also be found among geriatric inpatients. PATIENTS AND METHODS: The demographic data of inpatients of a geriatric clinic in Hannover in the years 1994, 2004 and 2014 were analyzed according to age, gender and classification as acute care or geriatric rehabilitation. RESULTS: The mean patient age rose by 6 years in the past two decades. This was the case for both men and women but the age of men (+7.5 years) rose more than that of women (+4.9 years). Whereas the patient average age increased, especially in the first decade (+3.9 years), this increase slowed down in the following decade (+1.7 years). The 80 to 89-year-old patients remained the biggest and steadily increasing group (in 1994: 41.1%, 2004: 46.9% and 2014: 51.3%). The greatest increase, however, was found for those aged 90 years and older (1994: 4.8%, 2004: 12.2% and 2014: 17.7%). CONCLUSION: The results confirm the professional experiences of many geriatricians in that they care for an increasingly aging clientele. Particularly very old male patients in geriatric clinics are increasing. All health professional groups involved will have to face this challenge.

[Influence of cognition on treatment outcome in geriatric patients: association between MMSE and gain in activities of daily living]. / Einfluss der Kognition auf die Behandlungsergebnisse in der Geriatrie : Zusammenhang von MMSE und Zugewinn in den Alltagsaktivitäten.

BACKGROUND: Cognitive impairment or dementia influence the results of geriatric treatment. The aim of the study was to quantify this influence. PATIENTS AND METHODS: Data of 2527 patients from the years 2006 to 2009 were analysed in order to quantify the influence of cognition measured with the Mini Mental Status Examination (MMSE) on the improvement of activities of daily living as reflected by the Functional Independence Measure (FIM). RESULTS: Impaired cognition is accompanied by a lower FIM score on admission and on discharge. But the improvement of the FIM of slightly cognitively impaired patients (MMSE 20-26) is the same as in patients without cognitive impairment (MMSE 27-30). Patients with a MMSE below 20 points have smaller improvements in their FIM score but nevertheless 40 % of the patients with a MMSE of 10-19 and still 30 % of the patients with a MMSE of 0-9 points show better improvements than the average of all patients. CONCLUSION: Patients with a MMSE below 20 should not generally be excluded from geriatric treatment, but individual factors should be considered.

The Protecting Role of Black Seed Oil and Its Nano-Formulation in LPS-Induced Acute Kidney Injury in Mice: Evaluation of Oxidative Stress, Biochemical & Molecular Parameters.

Background: Acute kidney injury (AKI) is a medical concern that is accompanied by the rapid deterioration of kidney function. It can be triggered by lipopolysaccharide (LPS) of gram-negative bacteria as it activates a complicated immune response, resulting in widespread inflammation and potential organ dysfunction. Black seed oil (BSO) is rich in beneficial constituents and has been widely used owing to its nutritional advantages. Purpose: This research is aimed to investigate the potential protective effects of BSO and its nano-formulation on AKI induced by LPS. It also aimed to compare their anti-inflammatory activity with indomethacin, a known synthetic anti-inflammatory drug. Materials and Methods: Forty-eight mice were placed randomly into 8 groups. A single intraperitoneal (i.p.) injection of 2.5 mg/kg B.W. of LPS was used to trigger inflammation, and pretreatment with BSO and its nano-formulation was at 0.2 mL/kg/day for 14 consecutive days. Indomethacin was used as a reference drug and its efficacy was tested alone or in combination with BSO at lower doses. Renal function was assessed using urea, creatinine, neutrophil gelatinase-associated lipocalin (NGAL) and kidney injury molecule-1 (KIM-1). Also, oxidative and inflammatory markers were assessed by measuring levels of reduced glutathione (GSH), nitric oxide (NO), cyclooxygenase-2 (COX-2), tumor necrosis factor alpha (TNF-α), and toll-like receptor-4 (TLR-4). Histopathological examination of the kidney tissues was also performed. Results: The study showed that BSO and its nano-formulation had anti-inflammatory effects comparable to or better than those of indomethacin. They greatly decreased the oxidative stress and inflammatory markers induced by LPS. Their protective effect against pathological alterations in kidney tissues was significantly noticed. Conclusion: BSO and its nano-formulation could be used as nephroprotective and anti-inflammatory supplements.

Sodium cotransport proteins.

Significant advances have been made in elucidating the structure of Na+ cotransport proteins. Some fifteen of these low-abundance proteins have been cloned, sequenced and functionally expressed. They are members of the 12 membrane-spanning superfamily and they segregate into two groups, the Na+/glucose (SGLT1) and Na+/Cl-/GABA (GAT-1) families. SGLT1 transporters are expressed in bacteria and animal cells, while GAT-1 transporters are mostly expressed in the brain. None have yet been found in plants.

Endocytosis of a cytotoxic human high density lipoprotein results in disruption of acidic intracellular vesicles and subsequent killing of African trypanosomes.

The host range of Trypanosoma brucei brucei is restricted by the cytolytic effects of human serum high-density lipoprotein (HDL). The lytic activity is caused by a minor subclass of human serum HDL called trypanosome lytic factor (TLF). TLF binds in the flagellar pocket to specific TLF-binding sites. Internalization and localization of TLF to a population of endocytic vesicles, and ultimately large lysosome-like vesicles, precedes lysis of T. b. brucei. The membranes of these large vesicles are disrupted by the accumulation of TLF particles. Inhibitor studies with lysosomotropic amines have shown these large vesicles to be acidic in nature and that prevention of their rupture spares the cells from TLF-mediated lysis. Furthermore, leupeptin inhibition suggests that a thioprotease may be involved in the mechanism of TLF-mediated lysis of T. b. brucei. Based on these results, we propose a lytic mechanism involving cell surface binding, endocytosis and lysosomal targeting. This is followed by lysosomal disruption and subsequent autodigestion of the cell.

[Tapering of antidementia drugs, antidepressants and antipsychotics in elderly patients : When possible, when not?] / Antidementiva, Antidepressiva und Neuroleptika bei alten Patienten absetzen : Wann möglich, wann nicht?

BACKGROUND: Antidementia drugs, antidepressants and antipsychotics are among the most frequently prescribed medication in old and multimorbid patients. Due to side effects (e. g. prolonged QTc interval) in emergency medicine/intensive care unit or patients' wishes the question is often raised whether these drugs can be stopped and how this may be done. ANTIDEMENTIA DRUGS: If the cognition is stable under antidementia drugs or if the patient is in favour of the medication, it should be continued. After stopping antidementia drugs there may be a deterioration of cognitive function in the following 2-3 months. This should be discussed with the patient and the relatives/caregiver. ANTIDEPRESSANTS: In case of only slight or reactive depressive mood antidepressants should be tapered. The dose should be reduced over a period of at least 4 weeks. A sudden stop may cause a withdrawal syndrome with flu-like symptoms, fatigue, tremor, insomnia, anxiety or confusion. In severe depressive episodes there is a high risk of relapse; therefore deprescribing should only be done after a stable remission of 4-9 months. ANTIPSYCHOTICS: Antipsychotics in dementia or nursing home patients as well as in cases of delirium should be tapered, whereby confusion may increase again. When antipsychotics were prescribed because of hallucinations or severe psychosis, they should not be reduced or only with great caution.

[Staff knowledge of radiation protection in endovascular surgery]. / Connaissances du personnel de chirurgie endovasculaire en radioprotection.

INTRODUCTION: Image intensification exposes the endovascular surgery staff to ionizing radiation. The aim of this study was to determine awareness of ionizing radiation risks among personnel working in the endovascular surgery environment and the availability of radiation protection clothes and to propose appropriate corrective measures. METHODS: This descriptive study was performed in the endovascular operating theatre equipped with a mobile image intensifier unit in La Rabta vascular department in September 2017. We visited the endovascular theatre to identify the availability of radiation protection clothes. We used a questionnaire to identify personnel knowledge about ionizing radiation. We established a global score of knowledge to classify our population. RESULTS: We identified 85 professionals exposed to ionizing radiation. Sixty-four of them (75%) responded to our questionnaire; 65% were male; median age was 34 years (range: 25-61). Endovascular theatre personnel were surgeons (35%), nurses (34%), qualified technicians (18%) and other department employees (13%). The mean global score of knowledge was 8.15/20 (2-18). This score increased significantly with grade and seniority (Kruskal-Wallis test). CONCLUSION: In the present study, the results indicate insufficiency knowledge about radiation exposure among the endovascular staff and in radioprotection tools availability. In order to minimize all unnecessary radiation, attempts should be made to increase vascular theatre staff knowledge about radiation protection. Safety culture is a referral method to reduce radiation exposure as low as possible.

Molecular analysis of a Neurospora crassa gene expressed during conidiation.

The asexual developmental pathway in the life cycle of the filamentous fungus Neurospora crassa culminates in the formation of spores called conidia. Several clones of genomic Neurospora DNA have been isolated that correspond to mRNA species expressed during conidiation and not during mycelial growth (V. Berlin and C. Yanofsky, Mol. Cell. Biol. 5:849-855, 1985). In this paper we describe the characterization of one of these clones, named pCon-10a. This clone contains two genes, con-10 and con-13, which are induced coordinately during the later stages of conidiation. The two genes are separated by 1.4 kilobases of DNA; they are located on linkage group IV and are transcribed from the same strand of DNA. The molecular organization and sequence of one of these genes, con-10, and its flanking regions are presented. Full-length cDNA clones for con-10 also were isolated and sequenced, and transcription-initiation and polyadenylation sites were defined. The con-10 gene contains an open reading frame interrupted by two small introns and encodes an 86-amino-acid residue polypeptide that is both hydrophilic and weakly acidic. Expression of the con-10 gene in various mutants defective at different stages of conidiation indicates that it plays a role after aerial hyphal development. Possible functions, organization, and regulation of conidiation-specific genes are discussed.

Alpha-lipoic acid as a new treatment option for Alzheimer's disease--a 48 months follow-up analysis.

Oxidative stress and neuronal energy depletion are characteristic biochemical hallmarks of Alzheimer's disease (AD). It is therefore conceivable that pro-energetic and antioxidant drugs such as alpha-lipoic acid might delay the onset or slow down the progression of the disease. In a previous study, 600mg alpha-lipoic acid was given daily to nine patients with AD (receiving a standard treatment with choline-esterase inhibitors) in an open-label study over an observation period of 12 months. The treatment led to a stabilization of cognitive functions in the study group, demonstrated by constant scores in two neuropsychological tests (the mini mental state exam, MMSE and the Alzheimer's disease assessment score cognitive subscale, ADAScog). In this report, we have extended the analysis to 43 patients over an observation period of up to 48 months. In patients with mild dementia (ADAScog < 15), the disease progressed extremely slowly (ADAScog: +1.2 points/year, MMSE: -0.6 points/year), in patients with moderate dementia at approximately twice the rate. However, the progression appears dramatically lower than data reported for untreated patients or patients on choline-esterase inhibitors in the second year of long-term studies. Despite the fact that this study was not double-blinded, placebo-controlled and randomized, our data suggest that treatment with alpha-lipoic acid might be a successful 'neuroprotective' therapy option for AD. However, a state-of-the-art phase II trial is needed urgently.

Interleukin-6 and selected plasma proteins in healthy persons of different ages.

In the present study, interleukin-6 (IL-6) and several acute phase proteins were measured in healthy participants (23-87 years of age). A linear correlation between IL-6 and age was established with an increase of 0.016 pg/ml (0.004) per year of life. Whereas CRP remained below 0.5 mg/dl in all participants, an increase with age for fibrinogen and an inverse relation for albumin as well as transferrin were obtained. However, the increase of IL-6 did not correlate with any of these changes. IL-6 associated diseases may therefore occur more often with advancing age, but in healthy participants IL-6 does not explain the changing plasma protein pattern resembling that of an acute phase reaction.

Genes expressed during conidiation in Neurospora crassa: molecular characterization of con-13.

Asexual development in Neurospora crassa proceeds through a series of discrete morphological stages that culminate in the production of dormant spores called conidia. Changes in the pattern of gene expression parallel the morphological transformations associated with conidiation. As a prerequisite to the analysis of developmental gene expression in N. crassa, several genes of unknown function that are preferentially expressed during conidiation were isolated [Berlin and Yanofsky, Mol. Cell. Biol. 5 (1985) 849-855]. The molecular structure and nucleotide sequence of one of these genes, designated con-13, is presented. The con-13 gene specifies a relatively rare 1.35-kb message which is first detected about 8 h following the induction of conidiation. Sequence analysis of both cDNA and genomic clones indicates that the con-13 gene consists of three exons divided by two small introns. It encodes a polypeptide of 340 amino acid residues (37.1 kDa). The Con-13 protein is weakly acidic and hydrophilic. A comparison of the regions upstream from the con-8, con-10, and con-13 genes revealed several short sequence motifs which may be important in developmental gene regulation.

Legumin encoding sequences from the redwood family (Taxodiaceae) reveal precursors lacking the conserved Asn-Gly processing site.

We have cloned and sequenced two different cDNAs encoding legumins from Japanese red cedar (Cryptomeria japonica, Taxodiaceae). The derived amino acid sequences show between 34% and 55% identity when compared with legumins from angiosperms and from Pinaceae, respectively. The predicted precursors are unusual in that they contain potential glycosylation signals, and we have found the corresponding beta-polypeptides actually to be glycosylated. As most outstanding feature one of the precursors is lacking the Asn-Gly processing site which has been assumed to be highly conserved in legumin gene evolution. Legumin encoding sequences amplified from genomic DNA suggest that these unusual precursors are widespread if not ubiquitous in the Taxodiaceae family. From previous reports on legumin precursors with divergent processing sites, on the proteases involved in legumin precursor processing and from the results presented here it is concluded that the Asn-Gly processing site has been acquired rather than conserved during legumin gene evolution.

Evolution of legumin genes: loss of an ancestral intron at the beginning of angiosperm diversification.

The polymerase chain reaction was used to survey gymnosperm legumin genes. Characterization of 46 cloned amplificates, differing in sequence and size (1.2-1.6 kb), revealed the ubiquitous occurrence of legumin genes and their organization in small subfamilies in the 22 species investigated. The 3' portions of the genes, coding for the legumin beta-polypeptides, show a highly conserved intron/exon structure divergent from those of angiosperms: an additional intron (intron IV) uniformly interrupts the region coding for the C-terminal part of the beta-polypeptides. Phylogenetic analysis of the respective coding sequences as well as the organization of the Magnolia B14 legumin gene also investigated here both indicate that intron IV is ancestral and was lost during early angiosperm evolution. Taking into account the intron/exon structures from all legumin genes known, our results suggest that legumin genes evolved by subsequent loss of introns, providing also further evidence for a common origin of legumins and vicilins.

The lysosomal targeting and intracellular metabolism of trypanosome lytic factor by Trypanosoma brucei brucei.

Trypanosome lytic factor (TLF) provides innate protection for humans against infection by the animal pathogen Trypanosoma brucei brucei but not against the agent of human African sleeping sickness, Trypanosoma brucei rhodesiense. TLF exists in two forms, TLF-1 and TLF-2. Prior studies suggested that TLF-1 causes lysosomal disruption and subsequent cell death in T. b. brucei. Here we confirm the lysosomal targeting of TLF-1 by immunolocalization with the trypanosome lysosomal membrane protein p67, and by co-fractionation of radiolabelled TLF-1 with lysosomal enzymes. In addition, pulse-chase studies indicate that TLF-1 is not degraded within the lysosome as compared to the host protein transferrin. In TLF-1 treated cells, transferrin is degraded normally, indicating that lysosomal proteases remain active during the early phase of TLF-1 treatment but fail to degrade TLF-1. Following endocytosis a TLF lipoprotein appears to undergo disulfide bond reduction prior to entering the lysosome. Results presented here indicate that TLF-1 lipoproteins are targeted to the lysosome but are resistant to trypanosome lysosomal proteases.

Reconstitution of the trypanolytic factor from components of a subspecies of human high-density lipoproteins.

Trypanosoma brucei brucei is non-infectious to man due to the sensitivity of these parasites to the lytic activity of normal human serum. Apolipoproteins (apo) have been purified, under non-denaturing conditions, from the subclass of human high-density lipoprotein (HDL), termed trypanosome lytic factor (TLF), which is responsible for the cytotoxicity of human serum to T. b. brucei. The TLF apolipoproteins were purified by anion exchange chromatography in the presence of the nonionic detergent octylglucoside and a reconstitution method was developed which allowed the role of the individual apolipoproteins and different lipids to be assessed. The results suggest that the TLF lipids do not have a direct role in lysis but are necessary for the correct assembly of the lytic HDL particle. Apo A-I, apo L-III and apo L-I contribute to lysis in reconstituted particles but individually they are not cytotoxic. Apo A-II was not required in the reconstituted TLF particle for trypanosome lysis. Formation of a lytic HDL particle required apo L-III suggesting its potential role as a toxin. Thermal inactivation of TLF activity correlated with the amount of denatured apo L-I, indicating that apo L-I was involved in lysis of T. b. brucei by native TLF.

Multi-facility survey of oligonucleotide synthesis and an examination of the performance of unpurified primers in automated DNA sequencing.

The purity of 208 crude synthetic 25- and 50-base oligonucleotides synthesized in 71 DNA core facilities was assessed by capillary electrophoresis (CE), and the average coupling efficiency of each synthesis was determined. The median average coupling efficiencies of the 25-mers and 50-mers were 98.9% and 98.7%, respectively, and 85% of the samples exceeded the minimum industry standard of 98% average coupling efficiency. The overall yields estimated by on-line trityl monitors showed poor agreement with the empirically determined yield, and accuracy of the monitors decreased as synthesis efficiency decreased. The performance of the unpurified 25-base oligonucleotides, ranging in purity from 14% to 94%, as primers for automated DNA sequencing was evaluated. Over 85% of these oligonucleotides exhibited an unedited sequencing accuracy of > 97.5% over the 400-base test sequence. Surprisingly, sequencing performance was not strictly related to primer purity, though a marked loss of performance was observed for primers < or = 70% pure (< or = 98.5% coupling efficiency). Thus, the vast majority of the oligonucleotides synthesized by the 71 core facilities participating in this study were of high quality and performed well as sequencing primers without post-synthesis purification or desalting. Finally, our results suggest that an increase in the standard minimum performance specifications of DNA synthesis instruments and reagents from > or = 98% to > or = 98.5% average coupling efficiency, or the development of rapid, inexpensive and efficient methods to detect syntheses below the 98.5% threshold, could obviate post synthesis purification of sequencing primers.